Q: Why did you decide to write
about PTSD and your own experiences with it?

A: I had always been generally aware of the idea of PTSD. My
dad was a Vietnam vet, and many of my neighbors were. I grew up near Miramar
air base. I grew up with Vietnam being this fraught thing.

When I first went to Iraq as a reporter, I came back in 2004
and…I felt apart and different from the average American. [I felt] upset about
the way the war was prosecuted...I didn’t feel that the deep moral violation in
Iraq was appreciated in the United States.

In 2007…an IED blew up the rear half of the Humvee [I was
riding in]. That was obviously a significant experience.

In 2009, I was in a movie theater watching an action film
with my girlfriend—an…explosion was depicted, and it freaked me out. I blacked
out, and when I came to, I was in the hallway of the Cineplex.

It was one of the hints I had that I was on the other side
of something. I tried to understand it, and began researching about PTSD.

I wanted to find something like Paul Fussell’s The Great War
and Modern Memory, or Kay Redfield Jamison’s [work], something vested in the
literature that would give me a greater literary sense of what PTSD was, that
would give me some of the history and situate it in the literature of
post-traumatic stress.

Q: You write, “For better or worse, the popular image of
PTSD is derived primarily from the image of the war-torn American veteran.” How
complete is that image?

A: It’s really incomplete in a sense. The popular concept
and the body of research relating to PTSD is heavily skewed to American
veterans. It’s not a complete picture. PTSD emerged from the veterans’
experience in Vietnam, a group of [antiwar] veterans advocated for what became
the PTSD concept.

For a very good reason, it’s associated with military
service, but if you could line up every PTSD sufferer on the planet, you would
see more female rape survivors. The PTSD diagnosis rape for rape survivors is
[about] 50 percent. For American military veterans, it’s 12 to 15 percent….

Q: In the book, you review the experiences of servicemembers
in wars before Vietnam, as well as more recent conflicts. How was
post-traumatic stress viewed in the conflicts before PTSD was recognized?

A: Post-traumatic stress evolved over time. British
researchers at King’s College went back and looked at accounts of British
veterans who served prior to the era of film, and there was no evidence of the
flashbacks associated with PTSD. American Civil War veterans were more likely
to report visitations by spirits or demons. There are aspects that are immortal…but
some aspects do evolve.

Q: What do you see as the most effective ways to help those
dealing with PTSD?

A: It’s important to recognize that every survivor’s
experience is different. There’s no magic bullet. Trauma can result from
millions of different situations. You have to address the type of trauma, and
the person in question needs to be addressed. You cannot really expect that one
particular therapy is going to resolve all symptom areas.

To look at the VA’s number one therapeutic modality—people
tend to take their cues from the VA…prolonged exposure. It works for about 60
percent of veterans. I was not among those 60 percent. It has pretty significant
side effects.

The second one, even more popular in the civilian sector, is
cognitive processing therapy, an outgrowth of cognitive behavioral therapy.
It’s a nice go-to, a lot less risky…

One friend who is a rape survivor [found that] prolonged
exposure did not work for her. She was not interested in reliving the event.
She found yoga helpful for her. It’s one reason I wrote the book the way I did;
it’s important to have a chapter on alternatives.

The VA will tell you something will work for you, but a
survivor needs to have [his or her] own journey. It’s one of the deeper themes
about PTSD…it’s helpful for survivors to make their own exploration and find
what works for them…

Q: What worked for you?

A: The second therapy, cognitive processing therapy, was
helpful. Additionally, on a non-therapeutic basis, I interviewed experts…the
intellectual exploration, keeping a journal, coming to conclusions on a
personal basis was helpful for me…

Q: You write that “many people do, in fact, grow from trauma and become better human
beings as a result of almost dying.” Does that apply to your own experiences?

A: Yeah, particularly after having written this book. The
number of discoveries I made…I did not want to put myself into in as many
dangerous situations. I believed there was an almost mystical value to be
gotten at by putting myself in harm’s way. I try to value normal life….

Winston Churchill said nothing is so exciting as being shot
at without results. You take insights from that moment, to try to live life in
that manner and understand how close you are to dying. It’s a powerful life
philosophy that I came to see in my own life.

Q: Two of the writers whose work you cite frequently in the
book are Tim O’Brien and Alice Sebold. What about their writing is especially
compelling for you?

A: Tim O’Brien is the most influential war writer of our
time, even apart from his obvious talent and the power of his work. [Writers
about Iraq] like Phil Klay, Ben Fountain, Kevin Powers, particularly with
Powers and Klay, there’s a sense of O’Brien’s work echoing for them.

My response is that I’ve always appreciated his ability to
play with time. In The Things They Carried, you see veterans with a very
dynamic experience with memory. In In the Lake of the Woods, there’s an
iterative revisiting of traumas that mimics the actual experience, the
aliveness of memory, the way it lives in all trauma survivors. It tends to
evolve and shift and haunt us…

Alice Sebold’s work is impossible to ignore if you’re trying
to understand a rape survivor’s experience. The literature of rape is very
thin... There’s no peer to Alice Sebold’s Lucky as a memoir. There are millions
of war memoirs, but almost no rape memoirs. It’s exquisitely well-written, and
it allows you a window into the experience….

I was able to interview Sebold in the course of writing the
book and trying to write about rape as a man. [Her work became] this guiding
spirit for me.

Q: How was your book’s title chosen?

A: The title was taken from one of the other [guiding] spirits
of the book, Siegfried Sassoon. In Sherston’s Progress, he was talking about
shellshock and how evil lies not necessarily in the heat of combat but [in the
suffering that comes later].

That was the first title I picked…I spoke with other trauma
survivors, and they said it worked. I spent a lot of time on the issue of time
in the book. The pain tends to come in waves. The idea of hours being evil, and
living through an hour of intense suffering, is more reflective of the
experience itself. The title seems apt.

Q: Are you working on another book?

A: I’ve started playing around with some ideas. I have a
novel I want to write, and there’s another nonfiction book I’m toying with.

Q: Anything else we should know?

A: I originally thought of PTSD as a boring subject. Most of
the coverage tends to be two things: a recapitulation of symptoms [or a portrait
of] a sad soldier and his…wife. I discovered there’s a very rich literature
relating to PTSD. There’s a lot of rich literary and emotional ground to cover.

If you step back from the issue, the really central question
is, How do you live after you’ve almost died? No one had posed the question
that way. The most central concern of all humans—we know we’re going to die…if
you’re given the privilege [of an early look at it], what are you going to do
with that knowledge?

For me, it’s far more than a soldier’s problem. It’s a very
central human concern.

About Me

Author, THE PRESIDENT AND ME: GEORGE WASHINGTON AND THE MAGIC HAT, new children's book (Schiffer, 2016). Co-author, with Marvin Kalb, of HAUNTING LEGACY: VIETNAM AND THE AMERICAN PRESIDENCY FROM FORD TO OBAMA (Brookings Institution Press, 2011).